A Diagnostic Dilemma for Chronic Rhinosinusitis: Definition Accuracy and Validity
Authors: Stankiewicz, James A.; Chow, James M.
Source: American Journal of Rhinology, Volume 16, Number 4, July-August 2002 , pp. 199-202(4)
Publisher: OceanSide Publications, Inc
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Abstract:
Background: The current definition of chronic rhinosinusitis is a symptom-based definition with minimal reliance on objective information. Based on this definition, patients are diagnosed and treated with medical therapy. A computed tomography (CT) scan is obtained only if the patient is not improved after medical therapy. No study is available evaluating in an evidence-based manner the accuracy of the current definition and its impact on diagnosis and treatment. Methods: This study represents 78 patients evaluated in a prospective fashion who met the subjective criteria for the definition of chronic rhinosinusitis. All patients underwent a complete history with a questionnaire evaluating symptom severity, a physical exam including anterior rhinoscopy and endoscopy, and a CT scan obtained on the day of their initial visit. Objective CT scan findings were compared with the subjective findings and related to the ultimate diagnosis of chronic sinusitis. Results: Only 37/78 (47%) had a positive (+) CT scan, indicating demonstrable sinusitis. There also was no real difference in symptom severity between patients with positive (+) and negative (-) CT scanning. Conclusion: The current symptom-based definition of chronic sinusitis poorly predicts whether a patient truly has chronic sinusitis and needs reevaluation.Document Type: Regular paper
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